Active NPI
Gabriel Leo Villavicencio, MD
- Student in an Organized Health Care Education/Training Program
- Las Vegas, NV
National Provider Identifier
1679374979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 4505 S Maryland Pkwy
Las Vegas, NV 89154-9900 - Phone
- (702) 855-3011
- NPI assigned
- Mar 22, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
4505 S Maryland Pkwy
Las Vegas, NV 89154-9900
Mailing address
1077 S Johnson St
Lakewood, CO 80226-4072
Phone (303) 378-0208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250814004454 | NV | Order and Referring Only - Internal Medicine | 1153820402 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742601600000",
"number": "1679374979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1077 S JOHNSON ST",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802264072",
"telephone_number": "303-378-0208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4505 S MARYLAND PKWY",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891549900",
"telephone_number": "702-855-3011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLAVICENCIO",
"first_name": "GABRIEL",
"middle_name": "LEO",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-03-22",
"last_updated": "2025-03-22",
"certification_date": "2025-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.